Current guidelines for the management of non-alcoholic fatty liver disease: A systematic review with comparative analysis

Abstract

The current epidemic of non-alcoholic fatty liver disease (NAFLD) is reshaping the field of hepatology all around the world. The widespread diffusion of metabolic risk factors such as obesity, type2-diabetes mellitus, and dyslipidemia has led to a worldwide diffusion of NAFLD. In parallel to the increased availability of effective anti-viral agents, NAFLD is rapidly becoming the most common cause of chronic liver disease in Western Countries, and a similar trend is expected in Eastern Countries in the next years. This epidemic and its consequences have prompted experts from all over the word in identifying effective strategies for the diagnosis, management, and treatment of NAFLD. Different scientific societies from Europe, America, and Asia-Pacific regions have proposed guidelines based on the most recent evidence about NAFLD. These guidelines are consistent with the key elements in the management of NAFLD, but still, show significant difference about some critical points. We reviewed the current literature in English language to identify the most recent scientific guidelines about NAFLD with the aim to find and critically analyse the main differences. We distinguished guidelines from 5 different scientific societies whose reputation is worldwide recognised and who are representative of the clinical practice in different geographical regions. Differences were noted in: the definition of NAFLD, the opportunity of NAFLD screening in high-risk patients, the non-invasive test proposed for the diagnosis of NAFLD and the identification of NAFLD patients with advanced fibrosis, in the follow-up protocols and, finally, in the treatment strategy (especially in the proposed pharmacological management). These difference have been discussed in the light of the possible evolution of the scenario of NAFLD in the next years.

Non‐alcoholic fatty liver disease in pediatric type 2 diabetes: Metabolic and histologic characteristics in 38 subjects

“…A recent meta‐analysis of the effects of the PPAR gamma agonist pioglitazone (a known insulin sensitizer) showed a tendency in lowering TGs (a small effect) and an increase in HDL . Although pioglitazone has shown some promise as a treatment modality for NASH, it is not considered as standard of care due to weight gain and other potential side effects …”

Docosahexaenoic acid and hydroxytyrosol co‐administration fully prevents liver steatosis and related parameters in mice subjected to high‐fat diet: A molecular approach

“…Collectively, these findings point toward oxidative stress as an important acting factor in the development in HFD‐dependent liver steatosis and establishment of a pro‐inflammatory state, which can further increase in NASH to progress into fibrosis and cirrhosis . Hence, abrogation of hepatic steatosis by combined DHA and HT would represent a crucial therapeutic strategy eluding disease progression into stages lacking efficacious handling at present time …”

“…70,71 Hence, abrogation of hepatic steatosis by combined DHA and HT would represent a crucial therapeutic strategy eluding disease progression into stages lacking efficacious handling at present time. [4][5][6]…”

Diet quality and its association with nonalcoholic fatty liver disease and all‐cause and cause‐specific mortality

“…Globally, the epidemic of obesity and type 2 diabetes mellitus have been increasing and the prevalence of NAFLD has also been increasing in tandem . While we have not fully understood mechanism of pathogenesis and factors contributory to the risk of NAFLD and related disease progression, current guidelines for the management of NAFLD set by reputable scientific societies independently agree on the importance of lifestyle modifications with weight loss by physical activity and diet modification . Despite the rapidly growing interest in managing NAFLD, data addressing the effects of diet quality and individual dietary components on NAFLD and all‐cause and cause‐specific mortality in patients with and without NAFLD are scant.…”

“…5 While we have not fully understood mechanism of pathogenesis and factors contributory to the risk of NAFLD and related disease progression, current guidelines for the management of NAFLD set by reputable scientific societies independently agree on the importance of lifestyle modifications with weight loss by physical activity and diet modification. 25 Despite the rapidly growing interest in managing NAFLD, data addressing the effects of diet quality and individual dietary components on NAFLD and all-cause and cause-specific mortality in patients with and without NAFLD are scant. We hypothesized that higher quality of diet and individual dietary components are inversely associated with the risk of NAFLD and positively associated with a lower risk for mortality in those with or without NAFLD.…”